Section 1

Rehabilitation hospitalizations are covered under which type of medicare?

Part A.

What is required from Medicare Part A for inpatient reahpilitation hospitals?

Preadmission screening to establish beneficiary's eligibility, Patient must be able to tolerate and benefit from 3 hours per day or 15 hours per week (7 consectutive days).

Regarding medicare Part A and Inpatient rehabilitation Hospitalizations "cost-sharing" and deductibles ?

Admissions directly from acute inpatient hospital do not pay a second deductible. Admissions from community do pay a deductible. (if a patient is coming from home the patient will have to pay a deductible).

CMS requires that inpatient rehabilitation services are reasonable and medically necessary, what are the requirements ("coverage criteria") ?

Documentation of preadmission screening, Close medical supervision, Director of rehabilitation, Plan of care, Coordinated multidisciplinary team approach. Must meet timeframes, required for payment under IRF PPS

What is IRF Patient Assessment Instrument (PAI)?

A data collection and reporting data collection tool that drives payment. IRF PAI must be completed twice for each Medicare Part A and Part C patient. (At admission and discharge).

Section 4

**In the RBRVS, what is another term for the element that represents the cost of malpractice insurance?

Professional liability insurance (PLI)

** In the RBRVS, what is the term for the across-the-board multiplier that transforms the geographically adjusted RVU into MPFS (Medicare physician fee schedule ) payment amount?

The Conversion Factor (CF)

** What does GPCI stand for?

Geographic Practice Cost Index is used along with Relative Value Units by Medicare to determine allowable payment amounts for medical procedures. There are multiple GPCIs: Cost of Living, Malpractice, and Practice Cost/Expense.

** True or False, Payments under the RBRVS (Resource-based relative value scale for physicians) are unaffected by the clinician's type?

False

** What tool does CMS require that SNFs use to collect and report clinical data about residents?

RUG (Resource Utilization Groups)

** What tool does the SNF PPS use annually to adjust payment rates?

The market basket index, which is based on the mix of goods and services included in the SNF prospective payment system (PPS). MDS - Minimum data set

** What cost sharing applies to beneficiaries residing in an LTCH for 90 days?

An inpatient deductible must be paid for the 90-day benefit period; plus, a daily coinsurance payment applies for the 61st through 90th day.

** True or False, Even though MS-LTC-DRGs differ form acute-care MS-DRGs because MS-LTC-DRGs have different relative weights and use quintiles for low volumes.